肥胖相关性高血压患者中心动脉压与靶器官损害相关性分析

Correlation between central arterial pressure and target organ damage in obesity-related hypertension patients

目的探讨肥胖相关性高血压患者靶器管损害程度和中心动脉压(CBP)对靶器管损害的影响.方法纳入徐州市中心医院2014年6月至2019年6月收住入院的高血压患者150例.根据高血压患者体重指数(BMI),将样本分为正常体重高血压组(BMI<24 kg/m^2)、超重高血压组(24 kg/m^2≤BMI<28 kg/m^2)和肥胖高血压组(BMI≥28 kg/m^2).比较三组患者靶器管损害的差异及其与中心动脉压和24 h动态血压的相关性.结果①与正常体重高血压组、超重高血压组比较,肥胖高血压组BMI[(21.86±0.71)kg/m^2比(25.97±1.10)kg/m^2比(30.96±1.09)kg/m^2]、腰围[(82.11±6.00)cm比(93.09±6.35)cm比(102.93±6.37)cm]、空腹血糖[(5.11±0.44)mmol/L比(5.26±0.68)mmol/L比(5.62±0.45)mmol/L]、同型半胱氨酸(Hcy)[(10.14±2.90)μmol/L比(12.33±4.07)μmol/L比(14.66±2.68)μmol/L]、高密度脂蛋白胆固醇(HDL-C)[(1.23±0.18)mmol/L比(1.13±0.22)mmol/L比(1.08±0.21)mmol/L]、低密度脂蛋白胆固醇(LDL-C)[(2.61±0.57)mmol/L比(2.89±0.47)mmol/L比(3.08±0.44)mmol/L]、颈-股脉搏波传导速度(c-fPWV)[(8.90±0.88)m/s比(9.60±1.70)m/s比(10.45±0.99)m/s]、左心室质量(LVM)[(143.59±18.73)g比(170.81±26.23)g比(218.24±41.93)g]、左心室质量指数(LVMI)[(85.34±10.96)g/m^2比(92.16±11.75)g/m^2比(105.16±18.23)g/m^2]和尿微量白蛋白(mALB)[(23.56±9.09)mg/24h比(27.80±12.55)mg/24h比(35.72±12.47)mg/24h]均较高(P<0.05).②高血压患者c-fPWV与中心动脉脉压差(CPP)呈正相关(r=0.580,P=0.001);LVMI与中心动脉收缩压(CSBP)呈正相关(r=0.279,P=0.004);mALB与CSBP呈正相关(r=0.333,P=0.001).结论体重增加可进一步加重高血压患者靶器管损害,中心动脉压较24 h动态血压对高血压患者靶器管损害更为密切.

Objective To study the extent of target organ damage and the effect of central arterial pressure(CBP)on target organ damage in obesity-related hypertension patients.Methods A total of 150 patients with hypertension admitted to Xuzhou Central Hospital from June 2014 to June 2019 were enrolled.According to the body mass index(BMI)of the patients,the samples were divided into normal weight hypertension group(BMI<24kg/m^2),overweight hypertension group(24 kg/m^2≤BMI<28 kg/m^2)and obesity hypertension group(BMI>28 kg/m^2).The differences of target organ damage among three groups and their correlation with central arterial pressure and 24-hour ambulatory blood pressure were compared.Results(1)Compared with normal weight hypertension group and overweight hypertension group,obese hypertension group had higher BMl[(21.86±0.71)kg/m^2 vs.(25.97±1.10)kg/m^2 vs.(30.96±1.09)kg/m^2],waist circumference[(82.11±6.00)cm vs.(93.09±6.35)cm vs.(102.93±6.37)cm],fasting blood glucose[(5.11±0.44)mmol/L vs.(5.26±0.68)mmol/L vs.(5.62±0.45)mmol/L],homocysteine(Hey)[(10.14±2.90)pmol/L vs.(12.33±4.07)pmol/L vs.(14.66±2.68)pmol/L],high density lipoprotein(HDL-C)[(1.23±0.18)mmol/Lvs.(1.13±0.22)mmol/Lvs.(I.08±0.21)mmol/L],low density lipoprotein(LDL-C)[(2.61±0.57)mmol/L vs.(2.89±0.47)mmol/L vs.(3.08±0.44)mmol/L],carotid-femoral pulse wave velocity(c-fPWV)[(8.90±0.88)m/s vs.(9.60±1.70)m/s vs.(10.45±0.99)m/s],left ventricular mass(LVM)[(143.59±18.73)g vs.(170.81±26.23)g vs.(218.24±41.93)g],left ventricular mass index(LVMI)[(85.34±10.96)g/m^2 vs.(92.16±11.75)g/m^2 vs.(105.16±18,23)gm^2]and urinary microalbumin(mALB)[(23.56±9.09)mg/24h vs.(27.80±12.55)mg/24h vs.(35.72±12.47)mg/24h](all P<0.05).(2)For hypertensive patients,c-fPWV was positively correlated with central arterial puise pressure(CPP)(r=0.580,P=0.001);LVMI was positively conelated with central arterial systolic pressure(CSBB)(P=0.279,P=0.004)and mALB positively correlated with CSBP(r=0.333,P=0.001).Conclusion Weight gain can further aggravate the target organ damage in hypertension patients.Compared with 24-hour ambulatory blood pressure,central arterial pressure is more closely related to target organ damage in patients with hypertension.